CONFERENCE REGISTRATION FORM
Seventeenth IEEE International Vacuum Electronics Conference (IVEC)
Monterey Marriott, 350 Calle Principal, Monterey, CA, April 19-21, 2016
PART I. NAME AND ADDRESS 

First Name

Initial

Last Name

Rank or Title

Company/Gov't Agency/University

Affiliation Address (Street/Avenue)

Mail Stop/P.O. Box/Code

City

State

Zip Code

Country

Phone Number

Fax Number

E-mail
PART II. REGISTRATION 
$700 *Advance Registration (before April 1) - IEEE Members ($775 Late or On Site)
$825 *Advance Registration (before April 1) - Non-Members ($875 Late or On Site)
$350 *Retired/IEEE Life Members
$200 * Full-time Students (proof of full-time student status will be required)
Additional Wednesday Evening Dinner and Entertainment Tickets @ $60 PER TICKET
Additional USB @ $30
* All registration categories include one Wednesday Dinner ticket and one USB of Abstracts.
PART III. PAYMENT INFORMATION
CREDIT CARD:  

VISA MasterCard AMEX Diner's Club

Card Number: Expiration Date:
 
Please note that IVEC credit card charges may appear as Palisades Convention Management on your credit card statement.
Forms with credit card payment may be faxed to (212) 460-5460 or mail form to: Ms. Alicia Waldron, IVEC
c/o Palisades Convention Management
411 Lafayette Street, Suite 201
New York, NY 10003
(212) 460-9700 or (800) 350-0111, awaldron@pcm411.com
Confirmations will be mailed. Refund requests will not be accepted after April 1, 2016